Thursday, July 1, 2010

Palms, Stars, Cards – Oh My!

Within our world we have recognized a handful of predictors of behavior change. Some of these include group counseling, medication, psycho-surgery, studies of religion, mechanical devices, palms - stars – cards – horoscopes, and principles of behavior analysis. It doesn’t matter to me that users can produce evidence to support the success of any of these predictors. What matters is that public funding streams for systems of support for people with intellectual disabilities typically rely on the last item in that list; principles of behavior analysis.

People that built their careers in this profession learned to concentrate on methods such as building behavior, occasioning behavior, extending behavior, and strengthening behavior. These methods offer opportunities and provide support for success. Sure, the principles of behavior analysis also include methods of decreasing and eliminating behavior. The principles run the full gamut of prediction of behavior. Generally, however, we are more interested in the building of behavior where it does not exist.

Sadly, funding streams in support of people with intellectual disabilities, Medicaid in particular, are more interested in the decreasing and elimination of problem behavior; specifically “remediation” of a behavior.

Here is a test: think up a preferred behavior that does not exist – increased frequency of telling funny jokes (imagine if we all did this). Now write this into a plan of care funded by Medicaid, and insist that you get assessment and intervention designed by a professional of behavior analysis to increase this behavior. You can be guaranteed that payment for this service will not be forthcoming.

On the other hand, if you focus on a “problem behavior”, such as frequent telling of off-color, humorless jokes, you very well might see payment for professional intervention. The funds only support a portion of the principles of behavior analysis.

Those responsible for funding streams assume that the building of new behavior happens naturally, without intervention, every day.

The reality is, for people who find it difficult to learn, building new desired behavior does not happen naturally every day. What happens naturally is just as likely to be not preferred. We need to see financial support for building behavior, occasioning behavior, extending behavior, and strengthening behavior.

You won’t win the World Cup by keeping the ball out of your own net. You must put the ball in the opponent’s net. This is done by recognizing the occasion to shoot, increasing the frequency and quality of shots on goal, and strengthening the support for shots taken.

Then again, what do I know?

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